Dirk Houttekier, PhD, researcher at the End-of-Life Care Research Group of Vrije Universiteit Brussel (VUB) and Ghent University explains the background to his longer research article that was selected as Editor’s Choice in the October edition of Palliative Medicine.

Dr Dirk Houttekier

Since the establishment of the End-of-Life Care Research Group at the Vrije Universiteit Brussel (VUB) and Ghent University, a prominent place has been given to large-scale epidemiological studies on place of death and transfers between health settings at the end of life. A high proportion of hospital deaths and frequent hospitalisations in the final stage of life are considered indicators of poor performance of end-of-life healthcare systems, with death and terminal care in the usual place of residence being considered a better outcome for the majority of patients. In the white paper defining optimal palliative care in older people with dementia, the European Association for Palliative Care recommends a conservative approach to hospitalisation of people with dementia, taking into account the associated risks and benefits, the goals of care and the stage of the dementia.

In people with dementia, especially in the more advanced stages of the disease, the place of residence is often a nursing home. In our previous work using death certificate data, we showed a decreasing trend in hospital death of people living in Belgian nursing homes, particularly in people who died from a dementia-related condition. However, the reliability of death certification of dementia is often debated and hospital death of people with dementia may be underestimated.

In our manuscript in Palliative Medicine on hospitalisations in the last month of life of people dying with dementia, we used a more reliable two-step method to identify nursing home residents dying with dementia. We showed that one in five nursing home residents dying with dementia were hospitalised in the last month of life, of which a quarter was admitted to an intensive care unit. Although hospitalisation in the last month of life of people with dementia residing in institutional care settings may be appropriate and unavoidable in certain situations, we were surprised about the high proportion of residents being hospitalised. The finding that the palliative care reference person of the nursing home was not involved in the hospitalisation decision in any of these cases is worrying and calls into question the model of palliative care in Belgian nursing homes.

Previously, we showed strong cross-national variation in place of death of people who died from dementia with hospital death being very low in the Netherlands. In Dutch nursing homes, care is managed by in-house specialist elderly care physicians and no longer by the resident’s own general practitioner, as is the case in Belgium. Is it time, given the high prevalence of dementia in many nursing homes, to consider the Dutch model in other countries?

You can download a free copy of the longer article…This post relates to the longer article, ‘Hospitalizations of nursing home residents with dementia in the last month of life: Results from a nationwide survey’ by Dirk Houttekier, An Vandervoort, Lieve Van den Block, Jenny T van der Steen, Robert Vander Stichele and Luc Deliens Palliat Med October 2014 28 (9);1110-1117. Published online before print 27 May 2014, DOI: 10.1177/0269216314535962.

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